Provider Demographics
NPI:1093919177
Name:CHILDRENS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON DUCKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-424-1856
Mailing Address - Street 1:331 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3868
Mailing Address - Country:US
Mailing Address - Phone:513-424-1856
Mailing Address - Fax:513-424-1850
Practice Address - Street 1:331 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3868
Practice Address - Country:US
Practice Address - Phone:513-424-1856
Practice Address - Fax:513-424-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID